Provider Demographics
NPI:1730655903
Name:HELLYER, THOMAS JAMES JR (MS, RD, LD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:HELLYER
Suffix:JR
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778427
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8427
Mailing Address - Country:US
Mailing Address - Phone:725-529-7989
Mailing Address - Fax:702-920-9966
Practice Address - Street 1:10120 S EASTERN AVE STE 115
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3952
Practice Address - Country:US
Practice Address - Phone:725-529-7989
Practice Address - Fax:702-920-9966
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730655903Medicaid